Balancing compassion amid constraints: A qualitative study of how system-level conditions shape midwives’ wellbeing when supporting asylum-seeking and refugee women’s mental health

Problem
Asylum‑seeking and refugee (ASR) women are at increased risk of perinatal mental health (PMH) difficulties but often face barriers to accessing appropriate support. Midwives play a central role in PMH assessment and referral, yet less is known about how system‑level constraints shape their capacity to support ASR women’s PMH or the implications for midwives’ wellbeing.

Background
Midwives in England are responsible for PMH screening and referral to support, but policy gaps and fragmented care systems contribute to decreased access to PMH services for ASR women in contrast to the general maternity population.

Aim
To explore how midwives experience and manage the emotional and systemic demands of supporting ASR women’s PMH needs.

Methods
A qualitative study using semi structured telephone interviews was conducted with 14 midwives across 13 NHS Trusts in England. This paper presents a focused analysis of midwives’ accounts from a wider study. Data were analysed using reflexive thematic analysis, with a salutogenic framework applied at the interpretive stage.

Findings
Three interrelated themes were generated: difficulties obtaining support for symptomatic women; emotional labour of the role; and limited training and guidance. Midwives’ capacity to support ASR women’s PMH was shaped by organisational resources, clarity of care pathways and access to supportive supervision, with implications for professional wellbeing.

Conclusion
Midwives frequently absorb the consequences of systemic limitations when supporting ASR women’s PMH. Strengthening organisational resources and addressing structural barriers may support more equitable PMH care while promoting sustainable midwifery wellbeing.